Background:

Atlantoaxial instability, also known as atlantoaxial subluxation, is only identified by radiographic studies with laxity increased between the anterior arch of the atlas and the odontoid process. When a patient has atlantoaxial instability, the incompetence of the transverse ligament or damage to the odontoid process allows a subsequent translation, with potential damage to the spinal cord; therefore, all patients with confirmed instability are restricted from participating in contact sports and sports that require bending or significant cervical flexo-extension.

Case report:

Nine-year-old female patient; she had practiced gymnastics for the past four years at a competitive level. She began her condition with a neck hyperflexion when falling down from trampoline training; she was managed in the emergency room with a diagnosis of cervical sprain grade I; dynamic radiographic studies and MRI were performed, which showed atlantoaxial subluxation and evidence of inflammation in the atlanto-odontoid space. She required surgery after a failed conservative treatment.

Conclusions:

Surgical treatment in patients with asymptomatic atlantoaxial subluxation is subject to controversy; arthrodesis is indicated in asymptomatic individuals to reduce the risk of spinal cord injury.